Provider Demographics
NPI:1134563679
Name:E. DAVID RISCH, M.D., P.A.
Entity type:Organization
Organization Name:E. DAVID RISCH, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:RISCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-916-1074
Mailing Address - Street 1:PO BOX 1459
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32178-1459
Mailing Address - Country:US
Mailing Address - Phone:386-916-1074
Mailing Address - Fax:
Practice Address - Street 1:6500 CRILL AVE
Practice Address - Street 2:E DAVID RISCH
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-9230
Practice Address - Country:US
Practice Address - Phone:386-916-1074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-27
Last Update Date:2013-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME39524207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066253400Medicaid
1437152840OtherTYPE 1 NPI
1437152840OtherTYPE 1 NPI
FL066253400Medicaid